The control function in educational institutions is carried out by internal and external bodies. Internal control is carried out by employees of the planning and economic department, accounting department and financially responsible persons in departments of the institution.

External control is carried out by higher organizations, as well as GosNI, KRU, Treasury and financial management.

The object of audit and control is the activities of the institution, namely the implementation of cost estimates.

The main share of the institution's expenses is wages. Therefore, control over the implementation of the cost estimate for this item is carried out first. The majority of the expenses for salaries of educational institutions are the salaries of teaching staff. Therefore, when analyzing the implementation of the estimate, it is necessary to pay special attention to the correct expenditure of these funds.

You should have a good understanding of the remuneration system for teaching staff of various types of educational institutions, established by current legislation. Salary rates for teachers depend on education and teaching experience.

The salaries of teachers and instructors may be higher or lower depending on the workload they perform and additional payments for performing the duties of class teachers, checking students’ written work, etc.

Example 4.20. Carry out a redistribution of cost estimates, avoiding overspending on budget items.

Index	Approved by estimate	Actual expenses	New estimate (possible option)
Salary
Office and business expenses
Maintenance and repair of fixed assets
Purchase of equipment and inventory
Travel expenses
other expenses
Total

Structure of health care institutions. Main types of medical institutions

Health care institutions play a special role in society fulfilling its social functions. Statistics show that out of 1 thousand people, 250 develop health problems within a month. Of these: 5 are in urgent need of emergency assistance; 9 – hospitalized; 1 – in treatment in a highly specialized center. The rest receive primary care.

Health care institutions are classified according to several criteria. In particular:

- by functions performed distinguished: hospitals, dispensaries, outpatient clinics, inpatient treatment facilities, dairy kitchens, maternity hospitals, research centers, sanatorium and resort institutions;

- by disease profile: neurological, cardiological, tuberculosis, etc.;

- by subordination: district, city, regional, republican;

- by industry: sectoral, territorial;

- by type of ownership: state, non-state.

5.2 Performance indicators of health care institutions.

Depending on the specifics of the institution’s activities, various indicators are used that reflect the scale of its work. In hospitals of all types, sanatoriums, rest homes, this is the number of beds; in outpatient clinics, this is the number of medical positions.

The main indicators that characterize the activities of a healthcare institution in Ukraine are presented in Table 5.1.

Table 5.1 – Activities of healthcare institutions

Index
1. Number of doctors of all specialties, thousand people. - per 10 thousand population	44,0	45,1	46,2	46,8
2. Number of paramedical personnel, thousand people. - per 10 thousand population	117,5	116,5	110,3	110,0
3. Number of medical institutions, thousand.	3,9	3,9	3,3	3,2
4. Number of treatment places, thousand - per 10 thousand population	135,5	125,1	95,0	96,6
5. Number of medical outpatient clinics, thousand.	6,9	7,2	7,4	7,4
6. Planned occupancy of outpatient clinics: - thousand visits per shift - per 10 thousand population	173,1	189,0	198,4	203,3
7. Number of emergency medical care stations (departments)
8. Number of persons who received assistance on an outpatient basis and during emergency calls: - million - per 1 thousand population	17,8	16,0	14,0	13,9
9. Number of independent dental clinics
10. Number of visits to doctors at outpatient appointments and visits by doctors to patients at home: - million - per resident	500,5 9,7	495,8 9,7	491,9 10,0	496,1 10,2
11. Number of people hospitalized in medical institutions of the M3 system of Ukraine, million - per 100 population	12,6 24,4	11,2 21,9	9,6 19,4	9,7 20,0
12. Average length of stay of a patient in hospital, days	16,4	16,8	14,9	14,6

To assess the quality and usefulness of health care organizations' services, special indicators can be used (Table 5.2).

Table 5.2 – Assessment of the quality of health services

The organization of the work of a healthcare institution depends on its passport tasks.

Example 5.1. Make a schedule for donating blood collected by the blood transfusion station to the donor center. The station has 7 blood storage boxes in use. 1 box holds 50 flasks of blood. The average blood donation per day is 150 people.

Solution: daily occupancy of boxes is 150: 50 = 3 boxes

existing boxes provide work for 2 days (7: 3 = 2.3 days)

The schedule for donating blood to the center is two days later on the third day.

The main indicators for assessing hospital performance are the average annual number of beds.

Average annual number of beds:

250*6/12=125 beds

Average annual number of beds:

(100*6+150*3)/12=87 beds

Example 5.4. In the existing hospital with 400 beds, it is planned to deploy an additional 100 beds, with the commissioning date: 50 beds from April 1 and 50 beds from July 1. Calculate the average annual number of beds.

Average annual number of beds:

400+(50*9+50*6)/12=462 beds

The quality of work performed by healthcare institutions is assessed by the timeliness and completeness of the implementation of a particular function. Thus, the characteristics of the average and maximum speed of response to a call help to judge the work of emergency medical services.

5.3 Health funds. Assessment of the institution’s provision with them.

In the structure of fixed assets of healthcare institutions, the largest share is occupied by equipment, tools, and household supplies.

Example 5.5. Determine the cost of fixed assets of the clinic at the end of the year.

Index	Buildings and constructions	Vehicles	Equipment	Household inventory	Tool	Furniture	Total
1.Balance at the beginning of the year	25120,6	18840,5	37681,0	22608,5	11304,3	10048,3	125603,2
2.Admission	41,39	56,8	93,32	74,95	14,45	33,93	314,84
- soft corner for the chief physician’s reception area						6,53	6,53
- ambulance		56,8					56,8
- warehouse for storing recycled items	18,78						18,78
- X-ray unit			45,8				45,8
- vacuum cleaners				45,3			45,3
- bunker for sterilization	22,61						22,61
- tonometers					1,05		1,05
- TVs				10,2			10,2
- sterilization unit			28,3				28,3
- conference room chairs						25,3	25,3
- glucometers					5,1		5,1
- humidifier			3,5				3,5
- air conditioners				18,6			18,6
- tomograph			15,72				15,72
- lawn mower				0,85			0,85
- single-pedestal tables						2,1	2,1
- boxes for sterilization					8,3		8,3
3.Balance at the end of the year	25161,99	18897,3	37774,32	22683,45	11318,75	10082,23	125918,04

The condition of fixed assets of healthcare institutions is assessed by the wear rate and service life. In this case, the service life is compared with the standard period.

The organization's provision of fixed assets is considered separately for each type of fixed assets. The absolute provision of the organization with fixed assets should be for those groups that are directly involved in the process of implementing the organization’s passport tasks (treatment of patients). Standards have been established for these groups. Based on the standards, an assessment is made of the actual availability of inventory and equipment and the need for them is determined.

Of particular importance is the energy supply system in case of extreme situations. In addition, vehicles require careful inspection.

An assessment of an organization's provision of fixed assets can be made by analytically comparing the cost of fixed assets with the indicators of similar organizations. If we are talking about a budgetary institution, then a comparison must be made with the cost of standard equipment established for this institution.

For a healthcare institution, it is important not only to have equipment, but also to use it effectively.

Example 5.6. Determine the load factor of the X-ray installation. The number of patients served per month is 1340 people, the rate of service for one patient is 4.5 minutes. The operating hours of the X-ray room are five days, from 8 a.m. to 4 p.m., with a break of 45 minutes. Friday from 8 to 14 without a break.

Working hours: 30 – 8 = 22 days

18 days * (480 – 45) + 4 days * 360 = 9270 minutes

Actual hours worked: 1340 * 4.5 = 6030 minutes

Equipment load factor: 6030: 9270 = 0.65

Working capital of healthcare institutions consists of medical supplies, dressings, linen, medical supplies (instruments), fuel and other working capital. The working capital of healthcare institutions can be replenished by importing funds. The import into the customs territory of Ukraine and the use of medical products in medical practice is allowed only with a permit issued by the State Department for Control of Quality, Safety and Production of Medicines and Medical Products.

Supply operations of medicines and medical devices registered and approved for use in Ukraine are exempt from VAT. The list of these funds is determined annually by the Cabinet of Ministers before September 1 of the previous reporting year.

You will learn:

• Why is it necessary to draw up a staffing schedule for a medical organization and in what form should it be drawn up?
• Who makes the staffing schedule?
• Are approved staffing standards taken into account when drawing up the staffing table?
• Should the names of the positions of medical workers in the staffing table correspond to the names contained in the qualification directories?

WHY IS THE STAFF SCHEDULE MADE AND IN WHAT FORM?

The staffing table must be drawn up to formalize the structure, staffing and staffing levels of a medical organization in accordance with its charter (regulations). The staffing table contains a list of structural units, names of positions, specialties, professions indicating qualifications, information on the number of staff units.

According to the explanations contained in the letter of Rostrud dated January 23, 2013 No. PG/409-6-1, this the document is being drawn up:

1. According to the unified form No. T-3(application).

In this case, it is signed by the head of the personnel service (HR department, personnel department) and the chief accountant, and approved by the head of the organization - the corresponding details (signatures, approval stamp) are provided for in the unified form. If there is no head of the personnel service (personnel department, personnel department) and (or) chief accountant on staff, the staffing table is signed by employees who are assigned such duties by order of the head of the medical organization (for example, an accountant and a human resources specialist). This follows from the Instructions for the use and completion of forms for recording labor and its payment (Form No. T-3), approved by Resolution No. 1.

2. Or in a form independently developed and approved by the employer- medical organization.

The document (like any local regulatory act (hereinafter referred to as LNA)) is approved by the head of the medical organization, and is signed by the responsible persons indicating their surnames and initials (other details necessary to identify these persons).

For medical organizations, approximate staffing forms have been developed, which are given in Appendices 1-3 to the Procedure for drawing up staffing schedules in healthcare institutions, approved by Order of the Ministry of Health and Medical Industry of Russia dated January 18, 1996 No. 16 “On the introduction of staffing forms for healthcare institutions.” Medical organizations can take these forms as a basis for developing their own staffing schedule.

WHO MAKES UP THE STAFF SCHEDULE?

According to the Qualification Directory of Positions of Managers, Specialists and Other Employees, approved by Resolution of the Ministry of Labor of Russia dated August 21, 1998 No. 37 (as amended on February 12, 2014), drawing up a staffing table is included in the job responsibilities of a labor economist. However, such a position is not available in every medical organization. Since the preparation of a staffing table is not assigned to a specific position or specialty by other regulatory documents, this function can be performed by both the head of a medical organization (chief physician, director, etc.) and any employee authorized by him (most often from the accounting department or the human resources department ).

STRUCTURE OF A MEDICAL ORGANIZATION AND STAFF REGULATIONS

The employer independently forms the structure of the organization, determines its numerical composition (number of staff units) and the conditions for remuneration of employees. The staffing schedule of a medical organization includes structural units, positions (professions) of employees, as well as the number of staff units for them. The structure and staffing levels are established by the head of the medical organization based on the volume of diagnostic and treatment work carried out and the size of the population served, taking into account the recommended staffing standards provided for in the procedure for providing medical care.

FOR YOUR INFORMATION

If subsequently the employer plans to hire employees for positions (professions) that are not on staff, it is advisable to include them in the staffing schedule of the medical organization immediately when drawing it up. Until employees are hired for these positions (professions), they will remain vacant (not occupied) in the staffing table.

As follows from the explanations contained in the letter of the Ministry of Health of Russia dated February 17, 2015 No. 16-4/9-57, staffing standards for medical and other personnel approved by orders of the Ministry of Health of the USSR, the Ministry of Health and Medical Industry of Russia, the Ministry of Health and Social Development of Russia, the Ministry of Health of Russia, including staff standards for employees and workers of state and municipal healthcare institutions, approved by Order of the Ministry of Health of Russia dated 06/09/2003 No. 230, based on the provisions of Part 1 of Art. 160 of the Labor Code of the Russian Federation, relate to labor standards.

Labor standardization systems are determined by the employer by issuing LNA, taking into account the opinion of the representative body of workers, or are established by a collective agreement (Articles 159, 162 of the Labor Code of the Russian Federation).

In addition, clause 4, part 3, art. 37 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (as amended on December 29, 2015) provides that the procedures for providing medical care are established recommended staffing standards for a medical organization and its structural divisions. Consequently, the staffing standards given in such regulations approved by the Russian Ministry of Health have advisory nature for a medical organization.

In other words, the head of a medical organization has the right independently form and approve the staffing schedule of a medical organization, unless otherwise provided by the legislation of the subject of the Russian Federation.

Compliance of the names of medical workers’ positions in the staffing table with the names contained in the qualification directories

The name of the employee’s position (profession, specialty) is indicated in the employment contract concluded with him, his work book and other personnel documents in accordance with the organization’s staffing table. If the performance of a certain job presupposes the presence of benefits or restrictions established by law, then the names of positions and qualification requirements for them must strictly comply with the names and requirements provided for in qualification reference books or the relevant provisions of professional standards.

For medical workers, the legislation provides, in particular:

• reduced working hours;
• provision of annual additional paid leave;
• for certain categories - early assignment of a retirement pension (old age).

For example, for medical workers included in the List of positions and institutions, work in which is counted in the length of service giving the right to early assignment of an old-age pension to persons who carried out medical and other activities to protect public health in health care institutions, in accordance with subparagraph. 20 clause 1 art. 27 of the Federal Law “On Labor Pensions in the Russian Federation”, approved. Decree of the Government of the Russian Federation dated October 29, 2002 No. 781 (as amended on May 26, 2009) provides for the early assignment of an old-age (old age) pension, and for medical workers included in section XL “Healthcare” of the List of industries, workshops, professions and positions with hazardous working conditions, work in which gives the right to additional leave and a reduced working day, approved by the Resolution of the State Committee for Labor of the USSR, the Presidium of the All-Union Central Council of Trade Unions dated October 25, 1974 No. 298/P-22 (as amended on May 29, 1991) - reduced working hours , provision of annual additional paid leave.

According to clause 4 of the Note to the Nomenclature of Positions of Medical Workers and Pharmaceutical Workers, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1183n (as amended on August 1, 2014; hereinafter referred to as the Nomenclature), the name of the doctor’s position is formed taking into account the specialty in which the employee has appropriate training, and work for which is included in the scope of his duties (for example, a general practitioner).

NOTE

In the event of a discrepancy between the names of positions provided for in the staffing table and the names of positions provided for in the Nomenclature, the employee may lose the right to establish benefits and compensation, as well as the right to early and preferential pension provision (letter of the Ministry of Health of Russia dated November 11, 2014 No. 16-4/3076092- 65421).

Currently, there are qualification reference books for various positions, professions, specialties, as well as professional standards approved by the Ministry of Labor of Russia (Article 195.1 of the Labor Code of the Russian Federation).

§ In relation to medical workers of a medical organization, it is necessary to be guided by:

The Unified Qualification Directory for positions of managers, specialists and employees, section “Qualification characteristics of positions of workers in the healthcare sector”, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n (hereinafter referred to as the Unified Qualification Directory);

Qualification requirements for medical and pharmaceutical workers with higher education in the field of training “Healthcare and Medical Sciences”, approved by Order of the Ministry of Health of Russia dated October 8, 2015 No. 707n;

The nomenclature of positions for medical workers and pharmaceutical workers, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1183n (as amended on August 1, 2014).

However, the titles of positions of senior officials in medical organizations in certain cases may not correspond qualification directories.

Thus, the Unified Qualification Directory does not include the qualification characteristics of deputy heads of medical organizations. The job responsibilities of these workers, the requirements for their knowledge and qualifications should be determined on the basis of the characteristics of the corresponding basic positions contained in the Unified Qualification Directory - heads of medical organizations.

In addition, the titles of the positions of deputy heads of a medical organization (chief physician, director, manager, chief) must be supplemented with the name of the section of work they are in charge of (for example, “deputy chief physician for medical affairs”, “deputy chief physician for nursing staff” and etc.). This follows from the norms of paragraph 3 of the Unified Qualification Directory, as well as the explanations contained in the letter of the Ministry of Health of Russia dated May 14, 2014 No. 16-4/3023499-2412.

Conclusions:

1. The staffing table is drawn up according to a unified form No. T-3, or according to a form independently developed and approved by a medical organization (approximate forms developed by the Ministry of Health and Medical Industry of Russia can be taken as a basis).
2. The staffing table can be drawn up by both the head of a medical organization and any employee authorized by him.
3. The staffing standards given in the procedures for providing medical care approved by the Ministry of Health of Russia are advisory in nature for a medical organization.
4. Unless otherwise provided by the legislation of a constituent entity of the Russian Federation, the head of a medical organization can independently form and approve the staffing table.
5. The job titles of medical workers, as a rule, must correspond to the names specified in qualification reference books or professional standards, with the exception of certain cases. If a position involves the establishment of benefits or restrictions, it must be indicated in the staffing table (employment contract, work book and other personnel documents) in accordance with the qualification directory and professional standard.

Approved by Resolution of the State Statistics Committee of Russia dated January 5, 2004 No. 1 “On approval of unified forms of primary accounting documentation for recording labor and its payment” (hereinafter referred to as Resolution No. 1).

Parts 2, 4 tbsp. 9 of the Federal Law of December 6, 2011 No. 402-FZ “On Accounting” (as amended on November 4, 2014; hereinafter referred to as Federal Law No. 402-FZ).

Lists of positions and institutions approved by Decree of the Government of the Russian Federation dated October 29, 2002 No. 781, are used for the early assignment of an old-age insurance pension in accordance with Art. 30 of the Federal Law of December 28, 2013 No. 400-FZ “On Insurance Pensions” (as amended on December 29, 2015) in the manner established by the Decree of the Government of the Russian Federation of July 16, 2014 No. 665.

6.1.1 The structure of medical organizations is determined by the medical-technical task (design task) taking into account their profile and capacity. Some units in the structure of a medical organization may be absent when the corresponding functions are transferred to centralized organizations (diagnostic center, central sterilization department, laboratory center, laundry, catering unit, cleaning service, pathology department, etc.).

6.1.2 Medical organizations intended directly for patients are divided into two groups: inpatient and outpatient. Medical organizations with a hospital may include the following structural units: hospitals, consultative and diagnostic departments, medical departments, auxiliary, economic, service and household premises, clinical department premises, day hospitals

6.1.3 It is advisable to design consultative, diagnostic and treatment units centralized with the possibility of using them by both inpatients and outpatients. For this purpose, separate entrances and waiting areas should be provided. In organizations with up to 150 beds, the entrance and waiting room may be common, but with a division of use by time.

6.1.4 Outpatient clinic organizations include: paramedic and obstetric stations (FAP), rural medical outpatient clinics (RVA), general practitioner offices, territorial, departmental and specialized clinics, dispensaries, medical centers, rehabilitation treatment centers without hospitals.

6.1.5 Outpatient clinic organizations may include the following structural units: outpatient clinic departments, consultative and diagnostic departments, treatment departments, day hospitals, auxiliary departments (including home care departments), economic departments, service departments.

6.2. Space-planning solutions for buildings

6.2.1 The planning structure of the building must ensure the flow (sequence) of technological processes, optimization of the routes of movement of the main flows of personnel, patients, hospital cargo in order to minimize their length and the convenience of patients, visitors and staff.

6.2.2 Streams of materials with a high degree of epidemiological danger should be isolated as much as possible from other streams using planning solutions or special equipment (closed carts, sealed waste containers, walk-through sterilizers and washing machines, barrier washing machines, etc.). Packed goods may be transported using public hospital elevators.

6.2.3 Ward departments, operating units, maternity units, intensive care units, laboratories, central care centers, and x-ray departments should not be walk-through areas.

6.2.4 To ensure the protection of patients and staff from nosocomial infections, various forms of spatial isolation should be used: reducing the capacity of ward departments; division of ward departments into sections; limiting the capacity of wards to one or two beds (including for mother and child staying together); individual delivery rooms in maternity wards, allocation of one or more single rooms in the ICU for isolation of patients. In addition, individual birth boxes may be provided in the emergency department; receiving diagnostic boxes;

6.2.5 At the entrance from stairs and elevators to ward sections, operating rooms, resuscitation and intensive care sections, as well as to the research area of ​​laboratories, a gateway or elevator hall should be provided.

6.2.6 To protect the readings of diagnostic equipment from distortion, functional diagnostic rooms are not recommended to be placed adjacent (including above and below them) to electro-phototherapy rooms, X-ray treatment rooms, magnetic resonance imaging and radiation therapy rooms, as well as rooms with sources of vibration.

6.2.7 Premises in which work is carried out with sources of ionizing radiation are not allowed to be located adjacent (including above and below) to wards for pregnant women and children.

6.2.8 Rooms for hydrogen sulfide and radon baths should not be located adjacent to wards. It is not recommended to place rooms with X-ray and other complex equipment under rooms with “wet” processes (showers, restrooms, washing areas, etc.). If another planning solution is not possible, waterproofing measures must be taken to prevent leaks.

6.2.9 For natural lighting of premises, planning solutions may provide for courtyards and atriums.

6.2.10 Natural, artificial and combined lighting of the main premises of medical organizations should be designed in accordance with Appendix N.

6.2.11 Free orientation of room windows along the horizon is allowed. The standard duration of insolation (SanPiN 2.2.1/2.1.1076) must be provided in at least 60% of the total number of wards of a medical organization. These wards do not include wards in which sun protection must be provided to protect against excessive insolation and harsh light (postoperative and maternity wards, wards in intensive care units, wards for nursing newborns and premature babies). For day hospital wards, the duration of insolation is not standardized.

In premises for permanent stay of patients and staff, oriented towards the southern point of the horizon, it is also necessary to provide sun protection.

6.2.12 In departments with patient reception rooms, waiting rooms (space) should be provided at the rate of 5 m 2 for each office or each place in the office (dental chair, couch, etc.). With the use of computer systems for regulating patient flows and when renovating buildings, the area can be reduced.

6.2.13 The area and dimensions of the wards must be determined based on the requirement of approaching the patient’s bed from three sides. A tripartite approach is not required for the beds in the living rooms of the sanatorium and the beds accompanying the patient (mothers in wards where mothers and children are staying together, etc.).

6.2.14 The distance from the end of the bed to the end of another bed or the wall of the ward must be at least 1.2 m. The distance between the long sides of adjacent beds must be at least 0.8 m, and in recovery rooms, neurosurgical, orthopedic and traumatological , burn rooms, medical and social rooms and wards for patients using wheelchairs - at least 1.2 m.

6.2.15 The dimensions of rooms and corridors of medical units should be taken according to Appendix D.

6.2.16 It is advisable to combine maternity and operating rooms, resuscitation and intensive care departments in one area with the creation of a common duty service for these units (express laboratories, blood storage services, emergency sterilization, etc.).

6.2.17 Sanitary checkpoints are designed separately for men and women. Sanitary checkpoints from three rooms (a storage room for general hospital clothing, a room for dressing staff in sterile clothing, a room for collecting used clothing) should be provided in operating rooms, maternity blocks, as well as sterile blocks of oncohematological and other departments for organ and tissue transplantation. Sanitary inspection rooms from two rooms (a storage room for general hospital clothes and a dressing room) - in the surgical intensive care unit, the intensive care unit for newborns and premature babies. In other departments with high requirements for the sanitary and epidemiological regime (therapeutic resuscitation, ward section for nursing newborns, etc.), a gateway is provided for putting on special clothing and washing hands. In the storage areas for general hospital clothing, a restroom and shower are provided. Showers are provided at the rate of one shower for 4 operating rooms (but not less than one) or for 6 posts of duty personnel.

6.2.18 According to the design assignment, a room for religious ceremonies with an area of ​​at least 12 sq.m. may be provided in the hospital structure.

6.2.19 In diagnostic departments and rehabilitation treatment departments, rest rooms are provided for patients after procedures at the rate of 2 m2 per relaxation chair and 4 m2 per relaxation couch. For resting patients in chairs in rehabilitation treatment departments, it is allowed to use light pockets in the corridors.

6.2.20 In medical, diagnostic and auxiliary premises of medical organizations, the minimum width of the doorway is taken according to table 6.1

At Anmo LLC, Eurasia Medical Center, the management process is carried out on the basis of a linear-functional management structure.

The essence of the linear management structure is that control influences on an object can be transferred only by one dominant person - the manager, who receives official information only from his directly subordinate persons, makes decisions on all issues related to the part of the object he manages, and is responsible for responsibility for his work.

Figure - 1 Organizational structure of LLC "Anmo" MC "Eurasia"

Advantages of the organizational structure of the health center: clear division of responsibilities among services, control, subordination, effective management.

At Anmo LLC, the Eurasia MC has a linear organizational structure. The diagram of the organizational structure and the composition of its divisions are shown in Fig. 1. The number of management levels is three.

Let's look at each division in more detail.

The administrative service consists of 4 administrators. The service reports directly to the economist-manager. The administrative assistant reports to the shift administrator.

Functions, economist-manager of a health center: carry out work to implement the economic activities of the center, aimed at increasing efficiency and profitability, the quality of patient care and the development of new types of services, achieving high final results with the optimal use of material, labor and financial resources.

Functions of the administrator of the Eurasia health center:

• - answers incoming calls to a medical institution in accordance with the rules for conducting telephone conversations;
• - opens a medical record for a patient visiting the health center for the first time before the initial consultation;
• - concludes an agreement with patients who visit the health center for the first time. The contract is filled out in two copies: one is handed over to the patient, the other is pasted into the patient’s medical record;
• - invite the patient to sit down and wait until the doctor invites the patient to go into the office;
• - warn the doctor about the arrival of the next patient; coordinates the passage of patients to the wellness center;
• - registers patients for primary and repeated treatment, according to the established temporary rules for receiving patients. In the case of an appointment with two specialists, the appointment is made with the assistance of the attending physician;
• - records appointments for consultations of primary patients using specialized software;
• - strive to minimize downtime in the doctor’s schedule by keeping a tight record and filling the resulting downtime with calls from patients of various categories;
• - conducts telephone conversations with patients in order to invite patients who have applied for services to the health center to a preventive examination, as well as calling patients who have not completed the full course of treatment;
• - conducts telephone conversations with patients in order to confirm the patient’s appointment with a doctor. Confirmation of the appointment is carried out the day before the patient makes an appointment (in the evening from 16.00 to 20.00);
• - carries out mailings to regular patients with information on various areas of work, promotions and new products of the health center;
• - select cards of patients who have an appointment with a doctor the next day. Card selection is carried out daily in the evening from 16-00 to 18-00;
• - organizes the exchange of necessary information within the health center team;
• - carries out payments to patients and issues checks to them; controls the safety of documentation and cash;
• - attends meetings of administrators within the time limits specified by the management of the center;
• - monitors the cleanliness and order in the hall, porch and corridors of the wellness center;
• - arrives to work early before the center opens;
• - complies with safety regulations and industrial sanitation.

Consider the financial service.

Functions of the chief accountant: ensuring a rational document flow system, using progressive forms and methods of accounting, based on modern computer technology, allowing for strict control over the rational and economical use of material, labor and financial resources.

The chief accountant is prohibited from accepting for execution and registration documents on transactions that contradict the law and violate contractual and financial discipline; in the event of receiving an order from the head of the enterprise to perform such an action, the chief accountant, without carrying it out, is obliged in writing to draw the attention of the head to the illegality of the order given by him. Upon receipt of a repeated written order from the manager, the chief accountant executes it, and reports facts of gross violation of the law to the prosecutor's office. In this case, the head of the enterprise bears full responsibility for the transaction; ensuring regular informing of the council of the labor collective and the general meeting (conference) about the results of financial and economic activities, audits, inspections, identified violations, those responsible, as well as ways to eliminate shortcomings in financial and economic activities, strengthen economic accounting and the financial position of the enterprise ; providing ongoing assistance in studying the basics of accounting by workers, employees and specialists of the enterprise in order to widely apply this knowledge in practical work to control the economical use of resources.

Functions of an accountant-cashier-personnel officer: carry out operations for receiving, accounting, issuing and storing cash and securities with mandatory compliance with the rules ensuring their safety, maintain a cash book based on receipts and expenditure documents, verify the actual availability of cash and securities with the book the remainder, forming a stable working team, creating a personnel reserve, organizing a personnel accounting system.

Functions of an engineer for the operation and repair of buildings: develops long-term and current plans; (schedules) of various types of repairs of equipment and other fixed assets of the enterprise (buildings, water supply systems, sewerage systems, air ducts, etc.), as well as measures to improve their operation and maintenance, monitors the implementation of approved plans (schedules); checks the technical condition of equipment, the quality of repair work, as well as the acceptance of equipment newly arriving at the enterprise, and, if necessary, draws up documentation for its write-off or transfer to other enterprises; organizes the preparation of repair work, determines the need for spare parts for equipment repair, to provide them to the enterprise on the terms of cooperation; exercises control over compliance with the rules of operation, maintenance and supervision of the equipment used; draws up the necessary technical documentation and maintains established reporting.

At the Eurasia health center, the positions of director and chief physician of the clinic are combined, the functions of the director are:

• - manages the healthcare institution in accordance with current legislation;
• - represents the healthcare institution in government, judicial, insurance and arbitration bodies;
• - organizes the work of the team to provide timely and high-quality medical and medicinal care to the population;
• - ensures the organization of treatment and preventive, administrative, economic and financial activities of the institution;
• - carries out an analysis of the activities of a healthcare institution and, based on an assessment of its performance indicators, takes the necessary measures to improve the forms and methods of work of the institution;
• - reviews and approves regulations on the structural divisions of the institution and job descriptions of employees;
• - monitors compliance with the requirements of internal labor regulations, safety regulations, labor protection, technical operation of devices, equipment and mechanisms.

The chief physician has the right:

• - request necessary information and documents from employees;
• - give employees mandatory instructions;
• - make decisions on the imposition of material and disciplinary penalties on employees who do not fulfill or improperly perform their official duties and on rewarding distinguished employees; take part in meetings, conferences, sections where issues related to professional competence are discussed.

The chief physician is responsible for:

• - for improper performance or non-fulfillment of their official duties provided for by this job description - within the limits determined by the current labor legislation of the Russian Federation;
• - for offenses committed in the course of carrying out their activities, - within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation;
• - for causing material damage - within the limits determined by the current labor and civil legislation of the Russian Federation.

Functions and responsibilities of the senior medical staff of LLC "Anmo" MC "Eurasia":

• - provides qualified medical care in his specialty, using modern methods of prevention, diagnosis, treatment and rehabilitation, approved for use in medical practice;
• - determines the tactics of patient management in accordance with established rules and standards;
• - develops a plan for examining the patient, clarifies the scope and rational methods of examining the patient in order to obtain complete and reliable diagnostic information in the shortest possible time;
• - based on clinical observations and examination, medical history, data from clinical, laboratory and instrumental studies, establishes (or confirms) a diagnosis;
• - in accordance with established rules and standards, prescribes and monitors the necessary treatment, organizes or independently carries out the necessary diagnostic, therapeutic, rehabilitation and preventive procedures and measures;
• - examines the patient daily in the hospital. Makes changes to the treatment plan depending on the patient’s condition and determines the need for additional examination methods;
• - provides advisory assistance to doctors of other departments of health care facilities in their specialty;
• - directs the work of the nursing and junior medical personnel subordinate to him (if any), facilitates the performance of his official duties;
• - monitors the correctness of diagnostic and therapeutic procedures, operation of instruments, apparatus and equipment, rational use of reagents and medications, compliance with safety and labor protection rules by nursing and junior medical personnel;
• - participates in conducting classes to improve the qualifications of medical personnel;
• - plans his work and analyzes his performance indicators; ensures timely and high-quality execution of medical and other documentation in accordance with established rules;
• - carries out sanitary educational work. Complies with the rules and principles of medical ethics and deontology;
• - competently and timely executes orders, instructions and instructions from the management of the institution, as well as regulatory legal acts related to his professional activities;
• - complies with internal regulations, fire and safety regulations, sanitary and epidemiological regime;
• - promptly takes measures, including timely informing management, to eliminate violations of safety regulations, fire safety and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors;
• - systematically improves his qualifications.

Functions and responsibilities of nursing staff:

• - fulfillment of duties provided for in the current job description;
• - providing medical care to the clinic’s clients (patients) in their specialty, using modern methods of prevention, diagnosis, treatment and rehabilitation accepted at the clinic;
• - in the absence of special knowledge and practical skills in the field of the latest methods and technological techniques introduced into the use of the clinic, active mastery of the specified knowledge and skills on the technological and methodological basis of the clinic, including through the acquisition of professional practical skills in the manner and under the conditions determined by internal local legal clinic standards;
• - compliance with the principles of medical ethics and deontology;
• - increasing professional level and qualifications;
• - careful attitude towards the property of the clinic and other employees;
• - management of the work of nursing staff;
• - performing tasks within his competence, corresponding to his specialty, qualifications and position, as well as orders (instructions) of the clinic administration;
• - maintaining medical confidentiality;
• - promoting the creation of a favorable business and moral climate in the clinic;
• - the obligation to maintain a business style of communication in communication with clients of the clinic, colleagues, nursing staff, other clinic personnel, and management of the clinic;
• - compliance with the terms of the employment contract and the current legislation of the Russian Federation;
• - compliance with the established Internal Labor Regulations, Regulations on the confidentiality of information constituting a trade secret of the clinic, production and financial discipline, and a conscientious attitude towards the performance of one’s official duties.

Our main priority is Human. We work with each of our patients as an individual. There cannot be two identical people, two identical problems, or standard diagnostic and treatment algorithms. Every Person is worthy of respect, understanding and compassion. This is the basis of successful treatment.

We are proud of our specialists. Our clinic is essentially an open, self-regulating system. This is a living organism. Every Person working with us is a professional and an individual capable of treating other people with respect and understanding. Our center welcomes healthy professional ambitions, but they do not run counter to universal human values. The disease makes a person vulnerable and vulnerable, therefore rudeness and profiteering with health are not acceptable in our center. Any thoughtless word, look, gesture can cause pain. Each of our employees, from the cleaner to the doctor, is a unique unit. These are people who come to us and stay for a long time.

At the present stage of socio-economic development of healthcare in its overall system, the role of primary health care in the overall process of improving the health of the people is significantly increasing, on which the overall growth in labor productivity of the entire society ultimately depends. The basis for solving this problem should be the effective organization of health care management and, above all, its lower levels - treatment and preventive institutions.

The existing organizational structure for managing the activities of a multidisciplinary hospital is a typical system of a rigid administrative-command style of management. With this management system, functional lines of communication diverge from the center to peripheral units (vertical connections). The divisions do not have established connections among themselves, which means there are practically no lines of horizontal communication.

Current issues of the team's activities are regulated by official regulations on all types of inpatient institutions and regulations on officials working in them. The management of the hospital, the procedure for admitting and discharging patients, the rights and responsibilities of medical personnel are regulated by special state norms, regulations and instructions. However, these documents have an organizing influence mainly on the production (medical) activities of the team inside the hospital. Issues regarding the current activities of the unit that go beyond the current provisions can only be resolved by contacting a higher authority. Most of these issues are of a resource nature. In addition, the relations between department teams cannot be resolved practically without the intervention of higher authorities. Thus, the vertical lines of management communication under the current organizational system are unnecessarily overloaded. A significant part of this load represents issues that can be resolved between medical workers or departments on the basis of mutual obligations, that is, the active development of horizontal connections, and vertical management connections will be unloaded.

In turn, the freed up time of managers of various ranks can be aimed at solving promising problems, such as improving the organization of work of health workers, introducing best practices, expanding contacts with other organizations and enterprises, and forming business relationships with related and other possible partners.

According to established tradition, a multidisciplinary hospital has 4 main functional divisions: management, hospital, clinic and administrative part. Each functional unit in turn consists of a number of structural units. Thus, the management of the hospital, in addition to the chief physician and his deputies (for the hospital, clinic, organizational and methodological work, administrative and economic parts), includes accounting, the personnel department, the registry, the service of chief and senior nurses, etc. The hospital consists of an admissions department , specialized ward departments, an operating unit, etc., a polyclinic - from treatment and consulting rooms of specialists and therapeutic areas, as well as a day hospital. Treatment and diagnostic services are presented separately for both the hospital and the clinic and include various types of laboratories and rooms: diagnostic, x-ray, clinical laboratory, physiotherapy service, etc. The AChC includes a repair and maintenance group, catering department, laundry, warehouses, MTS, garage, commandant's office, etc. In connection with the assignment to the multidisciplinary hospital of the functions of managing all medical and preventive institutions in the region, an organizational and methodological department was additionally introduced into its structure, which includes methodological, statistical rooms and an archive. The basis for the creation of a new organizational structure for the management of a multidisciplinary hospital in the conditions of a new medical and economic mechanism was based on the following basic principles:

The principle of limiting the number of hierarchical levels. Replacing the three- and four-level management system (chief physician - deputy for medical department - head of department - treating department) with a two-level system (administration - treating department) can significantly simplify the current management system. At the same time, the relationship between the administration and the treating department of the hospital is regulated on the basis of mutual contractual obligations;

The principle of optimization of control or management. The main idea of ​​this principle is to increase management efficiency by optimizing the number of direct subordinates. According to accepted standards, the total number of subordinates for heads of AUP and functional services should not exceed 7-9 people and be at least 5 (the so-called Muller number 7+ (-)2), and for heads of hospital departments should be set from 6 to 12 people depending on the volume and specifics of the work;

Principle of unity of command: no one person should receive orders from or report to more than one supervisor;

The principle of optimal division of labor. All operating functions of the hospital must be clearly divided between all structural units in order to eliminate their duplication, as well as the presence of “nobody’s” functions. Therefore, for effective management and elimination of duplication of management bodies at different levels, it is necessary to develop regulatory materials - regulations on institutions, their divisions, as well as job descriptions (regulations) for all hospital employees.

In the new conditions, in comparison with the current system of management organization, qualitatively new opportunities are opening up for solving the problems facing the team of medical workers. The scale of these opportunities is not a constantly given value, and with the development of superficial reserves of labor efficiency, subsequent deep-seated opportunities for its improvement and achievement of qualitatively new effective approaches will gradually be revealed. If such a development mechanism is correctly understood by every employee of the institution, then the desire of work collectives to quickly realize efficiency reserves at each workplace will develop objectively.

In turn, the development of initiative and activity of work collectives towards highly effective work cannot be carried out within the framework of a rigid administrative-command management system, when every movement or issue must be agreed upon and permission to be asked for its implementation from a higher organization. Such barriers must be removed and operational space must be provided for the development of independence. In this regard, the role of the democratic foundations of self-government is increasing with the gradual transition of management functions from the administration to the medical and auxiliary departments of the hospital.

An important structural unit of a multidisciplinary hospital is the Medical Council under the chief physician, which includes: the chief physician, his deputies, heads of departments, as well as a member of the deputy group on health care or a representative of the city administration, as well as representatives of enterprises, organizations and associations of the region.

The medical council under the chief physician is called upon to solve the following tasks aimed at developing the city’s healthcare:

1. Determine the prospects for the development of organizational forms of treatment and prevention of diseases,

2. Establish relationships and coordinate core activities with the activities of related institutions, form connections between the hospital and enterprises and organizations on the basis of creative collaboration and agreements.

3. Introduce the achievements of scientific and technical progress into the practice of the hospital,

4. Resolve issues of developing the hospital’s material and technical base, including placing applications for new medical equipment.

At this stage of development, such a hospital structure with the inclusion of a medical council under the chief physician is the most progressive and is capable of mobilizing the efforts of the team as an integral body to increase the efficiency of medical activities. The presented structure of the medical council will be flexible and dynamic if it is armed with regulations on its functioning, eliminating elements of duplication, ensuring the preservation of the independence of each of the structural divisions.

The gradual improvement of self-government ensures the active functioning of horizontal relationships, which means the interaction of departments without the intervention of the administration. These relationships must be based on objective, legalized norms and standards and be accompanied by a strictly thought-out system of accounting and control. An important condition for the effective functioning of the new system is a fairly clear understanding by each member of the large workforce about the working conditions and the implementation of relationships under the new system.

It is necessary to shift the center of gravity of organization and management from the administrative-command system to economic management methods.

One of the main points to improve the work of the hospital and expand the rights of the hospital will be the creation of a repair and maintenance cooperative. In this case, the relationship between the hospital and the cooperative is carried out on the basis of an agreement for certain types of work under the direct control and participation of the AHC. In turn, the reorganization and reduction of the ACh in connection with the delegation of some functions to the cooperative makes it possible for the hospital’s workforce to use the saved funds to develop the hospital’s material and technical base.

It is quite justified, in our opinion, to create an independent expert commission and legal service within the hospital structure to study issues of legal and social protection of the population of the region.

In connection with the transition to economic management methods, organizational management structures must be constantly improved and contribute to the gradual overcoming of managerial illiteracy of all members of the hospital team.

List of used literature:

1. Baida V.D. Quality management system for the treatment process in a hospital // Scientific organization in a large multidisciplinary hospital: Proceedings: All-Union Conference. Vroenezh, 1981.

2. Baida V.D., Pshenichkina V.D., Smelyanchuk L.I. and others. System of defect-free labor in a hospital. Kyiv: Health 1984-54 p.

3. Zhuzhanov O.T. Healthcare reforms in the Republic of Kazakhstan in market conditions. Dissertation for the degree of Doctor of Medical Sciences. - Orenburg, 1992.-48p.

4. Mirzabekov O.M., Ashimbaev B.U., Tompiev M.K. and others. Cost accounting and issues of efficiency of dental clinics of the Ministry of Health of the Kazakh SSR, Alma-Ata, KazNIINTI.-1990-No. 75-20p.

5. Problems of improving management and increasing production efficiency. Collection of scientific works.-M:ANKh under the Council of Ministers of the USSR-1983-234 p.

6. Reorganization of the healthcare structure in new economic conditions / Kucherenko V.Z., Mylnikova /, Soviet Medicine. - 1990. - No. 5. - pp. 60-63.

Abstract: The article examines and analyzes the basic principles of organizing the structure of management of the activities of multidisciplinary medical institutions in market conditions.

Abstract: The paper reviewed and analyzed the basic principles of structural organization, the management of multidisciplinary health care providers, market conditions.

Tuyin: Makalada naryktyk zhagdaydagi kop profili medicinaly k mekemelerdin qyzmetin baskar kurylymn yimdastyrudyn negizgi kagidalary talkylangan.